5 down the lower eyelid and keeping the eye closed for as Mydriatics and cycloplegics long as possible after application; one drop is all that is

588 11.5 down the lower eyelid and keeping the eye closed for as Mydriatics and cycloplegics long as possible after application; one drop is all that is

11.6 Treatment of glaucoma

589 needed. A small amount of eye ointment is applied

11.7 similarly; the ointment melts rapidly and blinking

Local anaesthetics

594 helps to spread it.

11.8 Miscellaneous ophthalmic

When two different eye-drop preparations are used at

preparations

594 the same time of day, dilution and overflow may occur

11.8.1 Tear deficiency, ocular lubri-

when one immediately follows the other. The patient cants, and astringents should therefore leave an interval of at least 5 minutes

between the two.

11.8.2 Ocular diagnostic and peri- Systemic effects may arise from absorption of drugs into operative preparations and

the general circulation from conjunctival vessels or from photodynamic treatment

the nasal mucosa after the excess preparation has

11.9 drained down through the tear ducts. The extent of Contact lenses 599

systemic absorption following ocular administration is

Eye

highly variable; nasal drainage of drugs is associated with eye drops much more often than with eye oint-

11 ments. Pressure on the lacrimal punctum for at least a minute after applying eye drops reduces nasolacrimal

drainage and therefore decreases systemic absorption from the nasal mucosa.

For warnings relating to eye drops and contact lenses, see section 11.9.

Eye lotions These are solutions for the irrigation of the conjunctival sac. They act mechanically to flush out irritants or foreign bodies as a first-aid treatment. Sterile sodium chloride 0.9% solution (section 11.8.1) is usually used. Clean water will suffice in an emergency.

Other preparations Subconjunctival injection may be used to administer anti-infective drugs, mydriatics, or corticosteroids for conditions not responding to topical therapy. The drug diffuses through the cornea and sclera to the anterior and posterior chambers and vitreous humour. However, because the dose-volume is limited (usually not more than 1 mL), this route is suitable only for drugs which are readily soluble.

Drugs such as antimicrobials and corticosteroids may

be administered systemically to treat susceptible eye conditions.

BNF 57

11.2 Control of microbial contamination 583

Preservatives and sensitisers Information on pre- Bacterial blepharitis is treated by application of an servatives and on substances identified as skin sensiti-

antibacterial eye ointment to the conjunctival sac or sers (see section 13.1.3) is provided under preparation

to the lid margins. Systemic treatment may occasion- entries.

ally be required and is usually undertaken after cultur- ing organisms from the lid margin and determining their antimicrobial sensitivity; antibiotics such as the tetracyclines given for 3 months or longer may be

11.2 appropriate. Control of microbial contamination Most cases of acute bacterial conjunctivitis are self-

limiting; where treatment is appropriate, antibacterial eye drops or an eye ointment are used. A poor response

Preparations for the eye should be sterile when issued. might indicate viral or allergic conjunctivitis. Gonococcal Eye drops in multiple-application containers include a

conjunctivitis is treated with systemic and topical anti- preservative but care should nevertheless be taken to

bacterials.

avoid contamination of the contents during use. Corneal ulcer and keratitis require specialist treatment Eye drops in multiple-application containers for domi-

and may call for hospital admission for intensive ther- ciliary use should not be used for more than 4 weeks

apy.

after first opening (unless otherwise stated). Endophthalmitis is a medical emergency which also calls Eye drops for use in hospital wards are normally dis-

for specialist management and often requires par- carded 1 week after first opening. Individual containers

enteral, subconjunctival, or intra-ocular administration should be provided for each patient. A separate bottle

of antimicrobials.

should be supplied for each eye only if there are special concerns about contamination. Containers used before an operation should be discarded at the time of the operation and fresh containers supplied. A fresh supply should also be provided upon discharge from hospital;

11.3.1 Antibacterials

in specialist ophthalmology units, it may be acceptable Bacterial infections are generally treated topically with to issue eye-drop bottles that have been dispensed to

eye drops and eye ointments. Systemic administration is the patient on the day of discharge.

sometimes appropriate in blepharitis. In out-patient departments single-application packs

Chloramphenicol has a broad spectrum of activity and should preferably be used; if multiple-application

is the drug of choice for superficial eye infections. Chlor- packs are used, they should be discarded at the end of

amphenicol eye drops are well tolerated and the recom- each day. In clinics for eye diseases and in accident and

mendation that chloramphenicol eye drops should be emergency departments, where the dangers of infection

avoided because of an increased risk of aplastic anaemia are high, single-application packs should be used; if a

is not well founded.

multiple-application pack is used, it should be discarded after single use.

Other antibacterials with a broad spectrum of activity include the quinolones, ciprofloxacin, levofloxacin,

Diagnostic dyes (e.g. fluorescein) should be used only and ofloxacin; the aminoglycosides, gentamicin and from single-application packs.

neomycin [unlicensed] are also active against a wide In eye surgery single-application containers should be

variety of bacteria. Gentamicin, quinolones, and poly-

used if possible; if a multiple-application pack is used, it myxin B are effective for infections caused by Pseudo- should be discarded after single use. Preparations used

monas aeruginosa .

Eye

during intra-ocular procedures and others that may Ciprofloxacin eye drops are licensed for corneal ulcers; penetrate into the anterior chamber must be isotonic

intensive application (especially in the first 2 days) is and without preservatives and buffered if necessary to a

required throughout the day and night. neutral pH. Specially formulated fluids should be used for intra-ocular surgery; intravenous infusion prepara-

Trachoma which results from chronic infection with tions are not suitable for this purpose. For all surgical

Chlamydia trachomatis can be treated with azithro- procedures, a previously unopened container is used for

mycin by mouth [unlicensed indication]. each patient.

Fusidic acid is useful for staphylococcal infections. Propamidine isetionate is of little value in bacterial

infections but is specific for the rare but potentially